Bite Elevation

Treatment for a "deep bite"

In most people, the teeth do not permanently meet the functional requirements of the masticatory system. Dental diseases such as tooth decay and periodontitis, as well as dental accidents or tooth abrasion, lead to tooth damage with loss of tooth substance and loss of bite height. These patients are referred to as abrasive dentition.

The dentist speaks of abrasive dentition when the teeth of the upper and lower jaw in the anterior and posterior teeth are equally affected by damage and wear of the tooth hard substances. The front teeth in particular become shorter and shorter over time. The typical tooth shape, tooth length and associated biomechanical function for each tooth are lost.

A bite elevation restores aesthetics and function in the mouth by restoring optimal jaw and tooth spacing. The treatment has not only an aesthetic aspect, but primarily a functional significance.

Bite elevation should not be considered in isolation without taking into account the causes of the misocclusion (tooth-to-tooth contact). It is important to ensure that these causes do not recur after the bite lift to ensure long-term success.

Publication: Bite Elevation Dr. Nina van Sprundel

What does bite elevation mean?

Bite elevation in dentistry is a procedure that is used to specifically change the distance between the upper and lower jaw in order to correct a bite position that is too deep. The dentition is brought back into an optimal position. A deep bite occurs when the upper incisors overlap the lower tips of the teeth. In extreme cases, this can even cause the lower teeth to bump into the roof of the mouth and put stress on the upper teeth.

For treatment, there are various methods of bite lifting, depending on the individual situation of the patient:

• Therapeutic bite lifting: This can be done passively through orthodontic measures, such as splints or other orthodontic treatments to bring the teeth into a correct position.
• Prosthetic bite elevation: This form of bite elevation is performed by bite splints or appropriately designed dentures when there is a bite prolapse due to abrasion or tooth loss.

Depending on the treatment situation, bite elevation can be performed by building up the posterior teeth, by shortening the front teeth, or by a combination of both procedures.

Children and adolescents go through three natural bite raises

In the case of physiological bite lifting, it is absolutely normal that when the first milk molars erupt at the age of 14-18 months, there is a change in the bite.

The second natural bite elevation occurs when the first molars erupt at the age of about 6 years.

The last bite elevation occurs when the premolar is changed and the 2nd molars are adjusted at the age of about 10-12 years.

For this reason, orthodontic examinations play a decisive role in the age of growth. With timely diagnosis and therapy, this can make it possible to correct misalignments before they manifest themselves in adulthood.

Effects of an untreated deep bite

The symptoms of the deep bite can affect the entire masticatory system and the body, which can have the following consequences:

• Sunken lower third of the face: change in the shape of the face as an aesthetic consequence, whereby the facial features appear asymmetrical and inharmonious.
• Eating behavior disorders and incorrect loads in the masticatory system
• Feelings of pressure, joint pain and tension in the head, neck and shoulder area
• Tension
• Pain in the back, hip and knee area
• Earache
• Tinnitus (ringing in the ears)
• Visual disturbances, such as eye flickering or double vision, accompanied by dizziness
• Difficulty swallowing in the morning due to lack of blood flow
• Pelvic obliquity

A deep bite should be treated by a dentist or orthodontist as soon as possible to avoid long-term damage.

If left untreated, a lowered bite can lead to other problems such as temporomandibular joint problems (arthropathy) or changes in the jaw muscles (myoarthropathy).

Causes of a deep bite (depression)

One of the main causes of the need for bite elevation is increased wear and tear on the teeth. This is referred to as abrasive dentition. This can be caused by a variety of factors:

• Teeth grinding and clenching of teeth (bruxism): This is a common cause of tooth wear, often due to stress. As soon as the nervous system and masticatory muscles come under pressure, many people tend to grind their teeth or clench them together at night in response to the psychoemotional stress. In this case, enormous forces occur, which wear down the tooth enamel and the underlying dentin in the long run.
• Misaligned teeth and incorrect loads in the masticatory system: Congenital tooth misalignments or tooth gaps can also contribute to the abrasion of the teeth. Also poorly adapted dentures such as crowns, implants, bridges, fillings or dentures and temporary prostheses can cause incorrect loading in the masticatory system and damage the surrounding teeth.
• Lack of prophylaxis: Inadequate oral hygiene and dental diseases such as caries or periodontitis can destroy the tooth structure and periodontium at an early stage.
• Bulimia and reflux disorders: Tooth enamel can be permanently damaged by constant exposure to stomach acid from vomiting and lead to tooth erosion.
• Alcohol abuse can lead to erosions. Patients suffering from chronic alcoholism often have erosions due to vomiting and reflux.

The bite lift requires sensitivity from all parties involved

The success of the bite lift depends crucially on the cooperation between the dentist and the dental technician and their mutual understanding of their respective areas of expertise. Constant education, questioning routines and learning new technologies are also essential to achieve the best possible treatment for our patients.

The ever-increasing possibilities and the support of CAD-CAM technology ensure a more efficient and safe process in our practice, both in the laboratory and during treatment. The possibilities range from the digital simulation of the target state to three-dimensional planning and representation, digital impressions and the production of the final dental prosthesis.

Dr. van Sprundel is the author of numerous publications on the subject of bite elevation after erosion damage and has extensive knowledge in diagnostics and treatment.

In our practice in Baar, we always plan sufficient time for individual consultation and treatment. This is the key to achieving the best possible outcomes for our patients. With Dr. Nina van Sprundel as a dentist, patients are in the best hands when it comes to the dental health and aesthetics of their teeth.

Planning and procedure of the bite lift

At the beginning of the treatment, a clinical functional analysis is carried out and impressions are taken. The clinical functional analysis and the technical analysis of the patient's study models provide information about which therapeutic measures are required.

If the teeth are not yet badly worn, the production of a Michigan splint to relieve the teeth and temporomandibular joint is the therapy of choice.

In the case of an advanced degree of destruction, restorative-prosthetic measures such as the restoration of the teeth with ceramic crowns and/or tabletops are required.

Before the therapeutic measures begin, a treatment simulation is carried out in the dental laboratory, which provides information about the aesthetic and therapeutic goal of the treatment. This shows the target situation as a wax-up on the patient's study models. A mockup on the patient demonstrates what their teeth and the resulting change in facial profile and physiognomy might look like after completion of therapy.

Step by step to the right bite

The wax-up is then transferred by the technician into a mock-up by temporarily transferring the shape of the teeth obtained on the wax model onto tooth-colored plastic shells. These so-called mock-ups are glued to one's own teeth with plastic.

In our practice, temporary and indirectly manufactured restorations are state-of-the-art in order to meet the highest quality standards. Alternatively, there is also splint therapy to try out the newly defined bite height.

In our practice, direct implementation with temporary dentures has proven to be effective in order to determine the optimal bite height. Such a test phase can last 3-12 months and finds its justification in the time it takes for the cranio-mandibular system to normalize and stabilize.

On the one hand, this ensures that the patient can get used to the newly acquired bite height and position. On the other hand, the decisive fine-tuning is carried out in this phase in order to achieve the individually optimal situation in the patient's mouth. The phonetics, function and feedback of chewing (mastication) are often already optimal during this time.

Further advantages of the temporary bite lifting during this time:

• Replacement of missing tooth substance: Temporary restorations replace the missing tooth substance and protect the affected area during treatment.
• Protection against irritations: Temporary prostheses protect the exposed tooth structure and the surrounding gums from chemical, physical and mechanical stimuli that could cause pain and inflammation.
• Stabilization of the tooth position: By inserting temporary restorations, the position of the teeth is stabilized until the final dentures are inserted. This stabilization is important to maintain the correct bite position and occlusion during treatment.

Overall, temporary restorations are an important part of the treatment process and contribute significantly to the successful and sustainable correction of the bite position. They ensure a gradual adaptation to the new conditions and offer the patient safety and comfort during treatment.

The patient plans his perfect smile with us

During the treatment phase, the patient can and should influence his or her later aesthetic appearance.

There are a number of appointments in our laboratory where the color and shape of the teeth are determined and optimized until the patient is satisfied with the final result. The temporary dentures are converted into the definitive dentures when the acclimatization period is completed.

After the final dentures are placed, the patient is given a Michigan splint for the night. This serves to protect and relieve the teeth and temporomandibular joint.

Insertion of the definitive dentures

The risk of non-acceptance by the patient is very low with the treatment strategy with temporary dentures. As is so often the case, a positive treatment result and a good doctor-patient relationship require detailed information about the consequences, risks and side effects of bite lifting.

In order to minimise risks, the definitive restoration of the teeth takes place at the earliest 3 months after the insertion of the temporary dentures. As a rule, the switch to high-end care is sought after 12 months at the latest. In the sessions, the crowns, partial crowns or bridges made of ceramic are integrated into the tried and tested bite position.

From our experience, patients quickly get used to dentures and gain significantly in quality of life.

Length of treatment and conclusion

The damage caused by an abrasive dentition can generally be completely repaired. However, good therapy planning, which may include various pre-treatments, is necessary to achieve an optimal result.

The duration of treatment depends on various factors, including the severity of the damage, the type of treatment, and individual circumstances. In general, we can distinguish the following treatment durations:

• For teeth that are not badly worn and treated with the help of the Michigan splint, the treatment lasts a few weeks with up to five appointments.
• In the case of advanced tooth substance loss, which may be treated with implant-supported dentures, and additional bone augmentation if necessary, the entire treatment can take about a year. During this time, however, patients wear highly esthetic and fixed long-term temporary prostheses, so that their quality of life is not restricted.

In order to avoid possible temporomandibular joint problems and dissatisfaction with aesthetics, a bite lift should not be carried out in a hurry. For this reason, a quick bite lift abroad, which often leads to disappointing results, should be refrained from.

It is advisable to seek advice and treatment from an experienced dentist in order to achieve the best possible result and eliminate possible fears and problems.

What are bite splints important for in aftercare?

Bite splints are important for the long-term maintenance of a healthy bite and the improvement of the quality of life of patients in the aftercare after a bite lift. They are an important tool for protecting dentures from wear and damage. This avoids repeated damage. The bite remains healthy in the long term.

In case of problems with the masticatory muscles, this individually adapted Michigan splint can help to relax the tense masticatory muscles and have a positive effect on the temporomandibular joints. Patients often wear the splint, especially at night, to counteract nocturnal teeth grinding or clenching (bruxism) and thus protect the teeth from renewed loss of substance.

In addition, a bite splint can also help to restore body balance in the case of body misalignments such as hip misalignments, spinal problems or leg length differences. The occlusal splint makes an important contribution to relieving the temporomandibular joints and harmonizing the bony structure of these joints.

How much does a bite elevation cost?

The treatment costs for a bite elevation are as individual as your situation. There are various treatment options for correcting a deep bite. Depending on the patient's wishes, lost tooth substance can be restored using dental plastics (composites) or dental ceramics (lithium disilicates, zirconium). Mixed treatments are also possible. This means that some teeth can be rebuilt with ceramics and others with composites. We would be happy to discuss the advantages and disadvantages of the various materials during a consultation.

Since a very extensive bite lift can be very costly, depending on the individual case and the material selected, our dental clinic offers the option of paying for the bite lift in interest-free installments.

Costs & Finance